Coronary Angiographic Patency in Patients With Acute Myocardial Infarction With or Without Thrombolytic Therapy

Background: The myocardial infarction (MI) is a leading cause of morbidity and mortality in developed countries as well as in developing countries including Bangladesh. Streptokinase since its introduction has been shown to reduce mortality significantly. The outcome of MI treated with streptokinase can be evaluated either by CAG measurement of TIMI blood flow or by the measurement of ST segment resolution in 12 lead ECG. Methods: This cross sectional comparative study was conducted in the department of Cardiology in Sylhet M A G Osmani Medical college, to compare the patency between MI patients with or without streptokinase therapy, from Jan 2008 to Dec 2009. Considering enrollment criteria a total of 96 patients with acute MI were evaluated. All patients were categorized into two groups. Group-I (n=48), who received streptokinase and Group-II (n=48), who did not received the same(due to late presentation). CAG was done with in 7- 28 days of on set of pain. The patients admitting in coronary care unit with the diagnosis of STEMI were taken as the study subjects. Results: Adequate TIMI (thrombolysis in myocardial infarction) flow was higher who received streptokinase (85.4%) than those who did not receive the therapy (52.1%). Conclusion: This study indicates that streptokinase therapy is associated with rapid and sustained reperfusion of the infarct related artery in the treatment of acute myocardial infarction. Keywords: Myocardial infarction; Thrombolytic therapy; Streptokinase; Coronary angiographic patency. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9182 Cardiovasc. J. 2011; 3(2): 136-142

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Electrocardiography changes in localizing the culprit vessel in acute myocardial infarction with angiographic correlations

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20192080 ◽

2019 ◽

Vol 6 (3) ◽

pp. 696

Author(s):

Senthil Kumar Sampath ◽

Vithiavathi Sivasubramanian ◽

Satish Lakshminarayanan

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Absolute Magnitude ◽

Cross Sectional Study ◽

Anterior Wall ◽

Inferior Wall ◽

Cross Sectional ◽

Medical College ◽

Infarct Related Artery

Background: The electrocardiogram is the primary diagnostic tool to evaluate a patient with chest pain and suspected myocardial infarction. Anterior wall infarction due to occlusion of proximal LAD has worse prognosis compared to distal or branch vessel lesions. Diagnosis of anterior/inferior/posterior or lateral MI is based on patterns of ST deviation and risk assessment based on absolute magnitude of ST segment deviation or the width of QRS complexes. Although coronary angiography is the gold standard for determining the infarct related artery in acute myocardial infarction, ECG can be useful tool in identifying the culprit artery involved at the primary care.Methods: A prospective cross-sectional study was conducted in Aarupadai Veedu Medical College and Hospital. Standard 12 lead electrocardiograph were recorded for 50 patients at a speed of 25 mm/s and voltage of 10mm/mv. Patients who had acute inferior wall MI additional right pericardial leads were recorded (V3R and V4R). The recorded ECG was interpreted using the electrocardiographic algorithms of Zimet-baum PJ et al. An ST elevation or depression was considered significant only if it was >1mm.Results: The study result showed maximum specificity for LCx (100%) followed by RCA (92.67) and LAD (89.91). The sensitivity for identifying the culprit artery by ECG in acute myocardial infarction was 100% for both LAD and RCA coronary artery but 0% for LCx coronary artery. In case of LAD occlusion, the sensitivity is 100% for proximal LAD occlusion and 92.86%for distal LAD occlusion. The sensitivity and specificity for proximal and distal RCA is 100% and 80.43% respectively.Conclusions: ECG is an easily, widely available and non-invasive tool to localize the site of culprit artery in acute myocardial infarction.

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Clinical effectiveness of thrombolytic therapy with alteplase and double antiplatelet therapy in acute myocardial infarction

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2011-6-59-63 ◽

2011 ◽

Vol 10 (6) ◽

pp. 59-63

Author(s):

D. N. Kuznetsov ◽

V. V. Trusov ◽

I. A. Kazakova

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thrombolytic Therapy ◽

Clinical Effectiveness ◽

Minute Volume ◽

Myocardial Salvage ◽

Group I ◽

General Weakness ◽

Number Of Patients ◽

Group Ii

Aim. To assess the clinical effectiveness of thrombolytic therapy (TLT) with alteplase in patients with acute myocardial infarction (AMI). Material and methods. The study included 54 AMI patients, divided into two groups: Group I (n=26), which underwent TLT, and Group II (n=28), which had contraindications to TLT. The TLT method was an accelerated alteplase infusion. Both groups were comparable by age and sex. In all patients, AMI biomarker levels and echocardiography (EchoCG) parameters were measured. Results. Successful thrombolysis was performed in 19 patients (73 %). The mean “symptom-to-needle” time was 3,7±0,6 hours. In Groups I and II, the 50 % reduction in the ST segment deviation from isoelectric line at 180 minutes was observed in 34,6 % and 0 % of the patients, respectively. In addition, in Group I, there was a reduction in the number of patients complaining of general weakness, dyspnoea, and recurrent angina attacks. The levels of cardio-specific AMI biomarkers were higher in Group II. According to the EchoCG results at 10 days after admission, the Group I patients demonstrated higher minute volume (by 28,8 %), higher ejection fraction (by 30 %), and higher end-diastolic dimension (by 23,8 %). Conclusion. The results obtained confirm high effectiveness of the in-hospital TLT with accelerated alteplase infusion. Alteplase therapy was associated with clinical and morphological myocardial salvage in AMI patients.

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Clinical Impacts of ST- Segment Non-Resolution after Thrombolysis for Myocardial Infarction

University Heart Journal ◽

10.3329/uhj.v15i1.41439 ◽

2019 ◽

Vol 15 (1) ◽

pp. 3-7

Author(s):

Syed Aminul Islam ◽

Md Faruque ◽

Fazlur Rahman ◽

Harisul Hoque ◽

Nilufar Fatema

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thrombolytic Therapy ◽

Early Mortality ◽

P Value ◽

Clinical Markers ◽

Average Hospital ◽

St Segment ◽

Clinical Consequences ◽

Streptokinase Therapy

Streptokinase therapy for acute myocardial infarction reduces early mortality and improves outcomes. Failure of reperfusion after streptokinase therapy for acute myocardial infarction is common and indicates a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 80 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as <50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Thrombolysis was successful, in terms of ST-segment resolution, in 59 patients (73.75%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. Average hospital stay was 2 days greater in non resolved ST-segment group than in ST-segment resolved group. At 6 weeks overall early mortality was much lower in the ST segment resolution group (1.7% versus 57.1% with P value of <0.001). So, non resolution of ST-segment in electrocardiogram following thrombolytic therapy in acute STEMI has paramount importance. If assessed routinely it might assist, along with other clinical markers, in the identification of high risk patients. University Heart Journal Vol. 15, No. 1, Jan 2019; 3-7

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Effectiveness of thrombolytic therapy in patients with acute myocardial infarction within 12 hours of symptoms

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202092 ◽

2020 ◽

Vol 8 (6) ◽

pp. 1985

Author(s):

Muneer Ahmad Siddiquei ◽

Zafar Iqbal ◽

Majid Bashir ◽

Mudassar Iqbal ◽

Syed Nouman Ali ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Thrombolytic Therapy ◽

Female Gender ◽

St Elevation Myocardial Infarction ◽

P Value ◽

Diabetic Patients ◽

Cross Sectional ◽

St Elevation

Background: Atherosclerotic coronary artery disease particularly myocardial infarction is the leading cause of morbidity and mortality all over the world and its incidence is also on the rise in Pakistan. This study was done to assess the effectiveness of thrombolytic therapy in patients with acute myocardial infarction and comparison between diabetics and non- diabetics.Methods: This cross sectional study was conducted at Department of Cardiology, Bahawal Victoria Hospital, Bahawalpur from January to June 2019. Total 380 patients of aged 30-70 years either male or female with diagnosis of acute ST-elevation myocardial infarction presenting within 12 hours of the onset of chest pain were selected. Patients were given thrombolytic therapy with Streptokinase 1.5 MIU over 1 hour and post therapy, efficacy was assessed.Results: Mean age of the patients was 51.37±10.08 years. Mean duration of diabetes mellitus was 5.99±3.47 years. Duration of chest pain ranged from 1 hour to 12 hours with mean duration of 4.66±2.98 hours. Out of 380 patients of MI, treatment was found effective in 202 (53.2%) patients. Female gender, type of MI, and duration of chest pain were significantly associated with reduced efficacy (p value < 0.05). Presence of hypertension, smoking, dyslipidemia or family history of MI did not alter the efficacy significantly (p>0.05) while patients having diabetes had significantly reduced efficacy (p value < 0.001).Conclusions: There is reduced effectiveness of thrombolytic therapy in diabetic patients with ST elevation myocardial infarction.

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Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000220 ◽

2015 ◽

Vol 85 (1-2) ◽

pp. 23-30 ◽

Cited By ~ 19

Author(s):

Aneta Aleksova ◽

Rita Belfiore ◽

Cosimo Carriere ◽

Salam Kassem ◽

Salvatore La Carrubba ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Primary Source ◽

Sun Exposure ◽

Female Gender ◽

Developed Countries ◽

Vitamin D Status ◽

High Exposure

Abstract. Background: Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area. Methods: Vitamin D status was identified in 478 subjects diagnosed with acute myocardial infarction. Results: The median serum 25-hydroxyvitamin D concentration was 14.5 [7.8 - 22.7] ng/mL. Vitamin D deficiency and insufficiency were present in 324 (68 %) and 107 (22 %) subjects, respectively. Vitamin D deficiency was less frequent among subjects enrolled in the period from July to the end of September (p < 0.001). In a multivariate analysis vitamin D deficiency was predicted by older age (p = 0.02), female gender (p = 0.002), higher body mass index (p = 0.05), autumn/winter sampling (p < 0.001), increased parathyroid hormone (p = 0.03) and alkaline phosphatase (p = 0.003). Conclusions: We observed very high prevalence of vitamin D deficiency among subjects with myocardial infarction in all seasons of enrollment. However, it was lower in the summer when sun exposure is higher. The exposure to sunlight may be a cost-saving therapeutic strategy for the management of vitamin D deficiency.

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